1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.

cholecystitis, cholangitis

Discussion in 'Current Medical Students' started by Eponine_hugo, Apr 5, 2010.

  1. Eponine_hugo

    Eponine_hugo New Member

    Joined:
    Dec 1, 2004
    Messages:
    2,357
    Likes Received:
    1
    Is there a way to CLINICALLY differentiate? I can't find this information anywhere.

    :) Not expecting answers, just a source to find the answer myself would suffice....


    Thanks
     
  2. brianfall

    brianfall New Member

    Joined:
    Jun 30, 2004
    Messages:
    539
    Likes Received:
    0
    According to the Oxford handbook of Gastroenerology and Hepatology;

    Cholangitis: infection of the biliary tree, usually arising form a combination of biliary obstruction and presence of bacteria
    Cholecystitis: inflammation of the gallbladder, which results from obstruction of the cystic duct by gallstones in 90% of cases

    Clinical features:

    Cholangitis: Classic triad of fever (>90%), jaundice (65%) and RUQ pain (>40%), although all three occur in <20% of cases.
    Cholecystitis: Most have prior history of biliary colic. Fever, nausea, vomiting often present, RUQ pain/guarding, palpable galbladder in 30% of cases. Jaundice suggests choledocholithasis or Mirizzi's syndrome (see defs below)

    So the differences seem to be that with cholecystitis, you're unlikely to get jaundice, and more likely to have a palpable gallbladder and a history of biliary colic.

    The differences are subtle, but I think looking at the anatomy of the area helps a bit;
    http://usmlemd.files.wordpress.com/2008/10/biliary20tract.jpg
    -i.e. in cholecystitis, it's the cystic duct leading directly from the gallbaldder that gets blocked, whereas in cholangitis it's the biliary tree (with the common bile duct as the trunk) and choledocholithasis it's the common bile duct that gets blocked. This anatomy explains (I think) why you're less likely to get jaundice in cholecystitis.

    Ultrasound is 90-95% sensitive and 80% specific for cholecystitis.

    choledocholithasis = common bile duct stones (I think)

    Mirizzi's syndrome = caused by compression of the common hepatic duct (see the diagram again)

    Hope that helps!
    B
     
    #2 brianfall, Apr 5, 2010
    Last edited: Apr 6, 2010
  3. melon

    melon Member

    Joined:
    Feb 13, 2006
    Messages:
    636
    Likes Received:
    0
    Everything brianfall has said is pretty spot on.

    The main difference is with cholangitis the patient will be very unwell. The classical triad mentioned above is called Charcot's triad: fever, RUQ pain and jaundice. With cholecystitis the only one of those you will have is RUQ pain. There may be a history of biliary colic with either as for cholangitis to develop you need some form of obstruction in the biliary tree.

    Cholecystitis affects the three F's: Fat, Female and Fourty.

    Also remember Courvoisier's law: In the presence of a palpable gall bladder, painless jaundice is unlikely to be caused by stones. E.g. cholangiocarcinoma instead.
     
  4. Eponine_hugo

    Eponine_hugo New Member

    Joined:
    Dec 1, 2004
    Messages:
    2,357
    Likes Received:
    1
    Thanks guys, I di8d wonder if the jaundice thing was it, but I was CONVINCED you could get jaundiced with cholecystitis too so that's where I was getting confused.....

    Brian, the anatomy was sooo useful, I didn't know the different ducts meant different disease! I thought it was both just the CBD, so thanks :)

    And Melon thanks for naming the law, I remembered the law itself but couldn't remember the name!!! :-D thanks guys, problem solved! :)
    xxx
     
  5. brianfall

    brianfall New Member

    Joined:
    Jun 30, 2004
    Messages:
    539
    Likes Received:
    0
    or cancer of the head of the pancreas.

    Just to confuse things, I think that in some cases you may be able to get jaundice with cholecystitis, but it is less common and should make you wonder if it's actually something else going on;

    http://emedicine.medscape.com/article/774443-overview
     
    #5 brianfall, Apr 6, 2010
    Last edited: Apr 6, 2010
  6. melon

    melon Member

    Joined:
    Feb 13, 2006
    Messages:
    636
    Likes Received:
    0
    Indeed:

    "Jaundice is unusual in the early stages of acute cholecystitis and may be found in fewer than 20% of patients. Frank jaundice should raise suspicion of concomitant choledocholithiasis or Mirizzi's syndrome (obstruction of the bile duct as a result of external compression of a stone in the gallbladder or cystic duct)."
     

Share This Page